1053640896 NPI number — MR. MICHAEL STEVEN GREENFIELD LMT MMP

Table of content: MR. MICHAEL STEVEN GREENFIELD LMT MMP (NPI 1053640896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053640896 NPI number — MR. MICHAEL STEVEN GREENFIELD LMT MMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENFIELD
Provider First Name:
MICHAEL
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMT MMP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053640896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1382
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL LAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60039-1382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-338-9180
Provider Business Mailing Address Fax Number:
847-854-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3915 THORNBERRY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE IN THE HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60156-4626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-338-9180
Provider Business Practice Location Address Fax Number:
847-854-1106
Provider Enumeration Date:
12/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  227.002789 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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